Pain Management in Palliative Care Setting

Managing pain in patients with serious illness in palliative care (PC) setting can be complex. However, pain is often a prominent symptom in patients with malignant and nonmalignant serious illness and providers have to be adept at balancing effective pain management and safety. Clinicians should start with a standard pain assessment that lays important groundwork for developing a tailored multimodal approach to pain management. It is vital to identify physical causes as well as psychosocial-existential reasons for the pain.

Pharmacological treatment forms the foundation of the management of pain in patients with advanced cancer. Although most of patients in the field of PC can be provided with acceptable pain relief using the three-step WHO cancer analgesic guidelines, a significant minority still have pain that cannot be controlled by conventional pharmacological management. Development of pain management strategies using a multidisciplinary team consisting of doctor, nurse, clinical psychologist, social worker, physiotherapist, and pastoral workers would be useful. And appropriate and timely use of interventional pain management techniques can provide satisfactory pain relief for some of these patients.

In fact, there are not too much evidence for pain control in non-cancer (e.g. organ failure) PC patients in the world. For those End Stage Renal Failure (ESRF) patients opted for conservative treatment, one local study of PC consultation for ESRF patients showed that 42% of the patients experienced pain symptoms and 58% of these patients rated their pain as moderate/severe by using numerical rating scale. The response rate to pain management was 53 % after the PC consultation. The authors showed that pain is common in ESRF patients receiving palliative care. While this seems to have been under-recognized, the symptom is potentially amenable to management. They recommend routine assessment of pain burden in this patient population.